PRIMARY LYMPHOMA OF THE STOMACH - 3-YEAR RESULTS OF A PROSPECTIVE MULTICENTER STUDY

Background: In October 1992, an ongoing prospective study on primary g astrointestinal (GI) lymphoma was initiated to evaluate histological f eatures, sites of involvement, and management. Patients and methods: U ntil May 1996, 352 patients were enrolled, with 279 being evaluable fo r clinical features (208 patients presented with primary gastric lymph oma). Standardized diagnostic workup included central histologic revie w and endoscopic and radiologic evaluation of the complete GI tract. P rimary surgery or conservative management depended on the physician's decision, followed by radiotherapy with or without chemotherapy. Treat ment outcome is evaluable in 122 patients with gastric lymphoma. Resul ts: In 279 evaluable patients, the distribution of NHL was as follows: stomach 74.6%, small bowel 8.6%, ileocoecal region 6.5%: multilocal G I involvement 6.8%. In gastric lymphoma, low-grade NHLs accounted for 39%. Of the remaining high-grade NHLs, 36.1% showed simultaneous low-g rade components, thus being also of MALT origin. Of 208 patients with gastric NHL, 71.1% were classified as stage I and II1. CCR rate in sto mach lymphoma is significantly higher compared to those of the small b owel, whereas involvement of multiple GI organs has the worst prognosi s. So far only 7 patients with gastric NHL in stages I and II presente d with progressive disease or relapse. Over all stages there seems to be no difference in therapeutic outcome in surgically or conservativel y treated patients. Even after R0-resection in limited stages patients appear to have no better outcome. Conclusion: The value of surgery in treatment of primary gastric lymphoma - as favored by most authors - should be reexamined.